title: Vulnerability to smokeless tobacco use among those dependent on alcohol or illicit drugs.
abstract: BACKGROUND
  Individuals dependent on alcohol or illicit drugs are vulnerable to cigarette smoking and related adverse health outcomes. Less research has been conducted regarding whether these same groups are vulnerable to smokeless tobacco (ST) use. The goal of this study is to examine vulnerability to ST use among individuals with other drug dependence.
  
  
  METHODS
  Utilizing the most recent (2011) National Survey on Drug Use and Health (NDSUH), we determined odds ratios (ORs) for current cigarette smoking and ST use among those with current alcohol, cocaine, heroin, and marijuana dependence, adjusting for relevant sociodemographic characteristics. Vulnerability to cigarette smoking was assessed to confirm that alcohol and illicit drug dependence were associated with increased smoking in these data sets, as shown in prior studies. Identical analyses were completed in the 2009 and 2010 NSDUH to assess generality.
  
  
  RESULTS
  Odds for current cigarette smoking were increased for each category of dependence (p < .0005): alcohol (OR with 99% CI = 3.30 [2.58, 4.21]), cocaine (OR = 4.50 [1.53, 13.20]), heroin (OR = 7.84 [1.92, 32.03]), and marijuana (OR = 3.55 [2.59, 4.88]). Odds for current ST use were also increased among those with alcohol dependence (OR = 1.56 [1.06, 2.30], p = .003) but not illicit drug dependence. Generality of the findings was confirmed in the 2009 and 2010 NSDUH.
  
  
  CONCLUSIONS
  Consistent with earlier reports, alcohol and illicit drug dependence are associated with robust increases in risk for cigarette smoking. In the case of alcohol dependence, but not illicit drug dependence, this vulnerability also extends to ST use.
authors.affiliation: Department of Psychiatry, University of Vermont, Burlington, VT;
authors.forename: Ryan
authors.initials: R
authors.lastname: Redner
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: White
authors.forename: Valerie S
authors.initials: VS
authors.lastname: Harder
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D013287:Illicit Drugs; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
chemical_list: D013287:Illicit Drugs